Health treaties are 'window dressing' to many nations

We know that human rights abuses often continue even when governments ratify international human rights treaties. Now it seems that many nations ignore treaty obligations to improve health services too.

“The public is led to believe that when a state makes a big deal about ratifying, they will do what they are promising, but quite often they don’t do anything,” says Edward Mills of the British Columbia Centre for Excellence in HIV/AIDS in Vancouver, Canada, and lead author of a global analysis exposing widespread neglect of treaty obligations to improve health. “We’re the first to look at health outcomes,” he adds.

‘Expose failures’

Mills found that signing international treaties made little difference to four key measures of health&colon; mortality rates of mothers, infants and children under five, and general life expectancy. “The only thing associated with progress was economic development,” he and his colleagues conclude.

Although 65 per cent of the 170 countries he analysed had signed six treaties obligating them to improve health, it made no difference to their performance, and in many countries, nothing had improved even 10 years after ratification. “It’s all window dressing,” says Mills.

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He says that the only way to force improvements is to oblige an independent monitoring body, such as the Institute for Health Metrics and Evaluation in Seattle, Washington, to track and expose progress, or lack of it.

Responding through its Office of the High Commissioner for Human Rights in Geneva, the UN said it was “unrealistic” to expect the situation to improve rapidly after ratification. “Ratification is only one of several factors affecting the speed of action,” said Maarit Kohonen, coordinator of the office’s Human Rights Economic and Social Issues Unit. Other political and economic factors can slow or speed up compliance, for example.

Treaties ‘crucial’

Kohonen agreed that a minority of countries ratify without following through, but she said that most do make efforts to meet their new obligations. She also defended the human rights treaty system overall. “The value of international human rights treaties, including those for improving health, is crucial to providing a universal, legally recognised framework to improve situations, such as national health outcomes.”

These units produce regular reports on all ratifying countries, starting with a report two years after ratification, with updates once every three or four years. Additionally, she says, the reports include data from independent NGOs, human rights groups and institutions, which means the final drafts are not reliant solely on data from a government, and so there is a counterweight to false and misleading data from corrupt governments.

“The treaty body system is as independent as it can be,” says Kohonen. Altogether, she says that the monitors now rely on about 30 indicators for health outcomes.